As the 2008 presidential campaign moves into its final stages, there is much enthusiasm within both parties for developing objective information on the effectiveness of medical treatments and therapies in real-world settings.

The health-quality measurement bandwagon is picking up steam these days as both public and private payers struggle to deal with rising costs and the need to ensure quality care. Medicare has greatly enhanced its "Hospital Compare" Web site by posting the results of a patient survey on satisfaction with care during hospital stays.

Despite widespread enthusiasm for establishing interoperative electronic health records, progress has been slow in developing the standards, protocols and rules needed to move from small initiatives to a national e-health system. To stimulate action, the Bush administration and major players in the e-health community are promoting electronic prescribing systems as an achievable step toward broader interconnectivity. Health plans and insurers are backing these efforts as a way to prevent medication errors and improve quality of care.

In response to continued complaints from Medicare beneficiaries about unscrupulous sales reps and misleading plan information, members of Congress and state insurance regulators are urging better oversight of Medicare Advantage and Part D plans. The Centers for Medicare and Medicaid Services (CMS) says it is beefing up policies and enforcing rules with more vigor.

Medicare Advantage plans escaped threatened payment cuts last year, but the issue is at the top of the health policy legislative agenda for the coming months. Legislation enacted in late December postponed a scheduled reduction in Medicare payments to physicians—but only for six months. Congress paid for that short delay plus an extension of the State Children's Health Insurance Program (SCHIP) without cutting MA rates or raising taxes.

As the debate over healthcare reform accelerates, policy makers are weighing in with proposals to unlink coverage from the work place.

Pressure is mounting on Capitol Hill once again to ax payments to Medicare Advantage plans. The legislators need to save $10 billion in order to rescind a planned cut in Medicare rates for physicians by year-end. Conveniently, the Congressional Budget Office (CBO) estimates that equalizing payments between MA plans and fee-for-service Medicare will save $50 billion over five years. If Congress wants to expand the State Children's Health Insurance Program (SCHIP) and keep physicians happy, "excessive" MA rates are the prime target.

There has been a lot of good news about the Medicare drug benefit lately. Surveys show a substantial increase in coverage, particularly among low-income seniors. Costs are less than expected; employers continue to offer retiree benefits; major insurers are sticking with the program; and product coverage remains fairly broad. Beneficiaries seem generally satisfied with the program, and the much-feared "donut hole" appears less lethal than anticipated.

The need to reauthorize the State Children's Health Insurance Program (SCHIP) by September 30, has evolved into a broader debate about the role of government in providing healthcare to Americans. The Bush administration wants to maintain a limited program for low-income children, while Democrats envision more open-ended coverage for more children and families.